Research roundup: Effectiveness of mobile clinics; Can more alternative medicine coverage save money?

Each week, KHN reporter Alvin Tran compiles a selection of recently released health policy studies and briefs.

Health Affairs: Mobile Clinic In Massachusetts Associated With Cost Savings From Lowering Blood Pressure And Emergency Department Use – Approximately 2,000 mobile health clinics in the U.S. have 6.5 million patient visits annually. Researchers analyzed data from nearly 6,000 patients from 2010 to 2012 from one program, to examine the clinical impact and cost-effectiveness and found: "Our pilot evaluation suggests that this model can be effective in supporting reductions in blood pressure in underserved communities. It also suggests that mobile clinics can be cost-effective as a delivery model for primary and secondary preventive care, based on savings from health improvement and emergency department avoidance. ... policy makers should consider mobile clinics as a delivery model for underserved communities with poor health status and high use of emergency departments" (Song et al, 1/2013). 

Health Affairs: US Spending On Complementary And Alternative Medicine During 2002-08 Plateaued, Suggesting Role In Reformed Health System – The authors write that complementary and alternative medicine services are "equal to 3 percent of national ambulatory health care expenditures, and the care "is primarily paid for out of pocket, although some services are covered by most health insurance. ... Our findings suggest that any attempt to reduce national health care spending by eliminating coverage for complementary and alternative medicine would have little impact at best." They conclude that if some forms of this medicine are proven "more efficient than allopathic and specialty medicine, the inclusion of complementary and alternative medicine providers in new delivery systems such as accountable care organizations could help slow" health spending growth (Davis, Martin, Coulter and Weeks, 1/2013).  

Kaiser Family Foundation: Implementing New Private Health Insurance Market Rules – Under the health law, significant changes in private health insurance are set to take place January 1, 2014. This new Kaiser Family Foundation issue brief "looks at three proposed federal regulations released in late November 2012 that detail how the ACA's rules will operate in the following areas: private insurance market reforms, essential health benefits and actuarial value, and wellness programs offered or required by employers under group health plans." The proposed regulations "deal with aspects of the ACA intended to promote broader risk pooling, prohibit discrimination based on health status, enhance insurance market efficiency and affordability, promote wellness, and improve consumer protections" (1/8).

Here is a selection of news coverage of other recent research:

Reuters: Fewer Americans Saw Doctors During "Great Recession"
Americans made fewer trips to their doctors' offices during the Great Recession than they did earlier in the decade, according to new research. "These are not dramatic drops, but in our healthcare system we're used to our numbers going up... So just seeing a reverse in the trend is interesting," said Karoline Mortensen, the study's lead author from the University of Maryland in College Park. Using a national database of medical expenses from about 54,000 people between the ages of 18 and 64 years old, Mortensen and her colleague compared how many times people of different races used health services during two-year periods before the recession (2005 and 2006) and during it (2008 and 2009) (Seaman, 1/9). 

Medscape: EHRs: Small Practices Need Sustained Technical Help
Only those physicians who received extensive, sustained, technical assistance with electronic health records (EHRs) had significant improvements in quality of care, according to a study published in the January issue of Health Affairs. This study of small physician practices in New York City also showed that quality improved only for a limited group of measures. "EHRs were once thought to be a cure-all for helping improve patient care, but there are implementation issues and the technology has a steep learning curve," lead author Andrew M. Ryan, PhD, assistant professor of public health at Weill Cornell Medical College, New York City, said (Barclay, 1/9).

Medscape: HPV Cancers Increase, Vaccination Rates Remain Low
A rise in cancers associated with human papillomavirus (HPV) in the United States is highlighted in the Annual Report to the Nation on the Status of Cancer, which was published online January 7 in the Journal of the National Cancer Institute. The authors of the report, as well as other experts, have used these data to emphasize the potential of the HPV vaccination. ... In 2010, 32.0% of American girls 13 to 17 years of age had received 3 doses of the HPV vaccine. Coverage was significantly lower than the national average in those without insurance (14.1%). It was also significantly lower in some of the Southern states (20.0%), which have the highest rates of cervical cancer and the lowest prevalence of recent Pap testing (Nelson, 1/9). 

Medscape: Physician Online Ratings Unreliable, Easily Skewed
Web site physician ratings are based on input from only 2.4 patients on average, according to a study published online December 10, 2012, in the Journal of Urology. "Our findings suggest that consumers should take these ratings with a grain of salt," said first author Chandy Ellimoottil, MD, urology resident from the Loyola University Medical Center in Maywood, Illinois, in a news release, noting that the ratings can be easily skewed by 1 or 2 very happy (or unhappy) patients, rendering them unreliable (Waknine, 1/9). 

MedPage Today: Study Reports Reflect Researchers' Bias
A third of randomized clinical trials (RCTs) in breast cancer had published results that showed bias in the reporting of endpoints, and two-thirds showed bias in reporting toxicity, authors of a literature review concluded. Of 164 studies included in the review, 54 (32.9%) had positive results that were not based on the primary endpoint, which was not statistically different (Bankhead, 1/10).